Endoscopy 2021; 53(06): E228-E229
DOI: 10.1055/a-1244-9305
E-Videos

Successful endoscopic extraction of a missing proximal esophageal foreign body

Lijuan Yang
Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
,
Xiao Han
Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
,
Min Xu
Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
,
Rong Wan
Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
,
Xiaobo Cai
Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
› Author Affiliations
 

A 32-year-old man swallowed a piece of iron wire by mistake approximately 8 weeks before admission. Computed tomography (CT) of the larynx showed a short, high-density strip, judged to be a foreign body (about 6 – 8 mm long at level 6/7 of the cervical vertebra), in the upper esophagus ([Fig. 1]). No abnormal findings resulted from several gastroscopy and laryngoscopy examinations in the local hospital, indicating that the foreign body was embedded under the mucosal layer. The patient was very anxious and insisted doctors remove it.

Zoom Image
Fig. 1 Computed tomography of the larynx showing high-density foreign body in the wall of the upper esophagus (at about level 6/7 of the cervical vertebra) (arrow).

We first used endoscopic ultrasound and real-time X-ray monitoring to mark the foreign body, but both failed due to the foreign body’s difficult position. We therefore endoscopically fixed three titanium clips at different positions of the upper esophagus based on the appearance of the previous CT scan and determined the location of the foreign body by a second CT scan ([Fig. 2]). Endoscopic submucosal dissection (ESD) was then performed just near the esophageal entrance (1 – 2 cm from the entrance) and the submucosal foreign body was found and removed ([Fig. 3], [Fig. 4], [Video 1]). The wound was then closed by clips. An additional CT scan was performed 1 month later, confirming that the foreign body had been removed ([Fig. 5]).

Zoom Image
Fig. 2 The position of the foreign body (yellow arrow) was determined by titanium clip (red arrow) combined with the computed tomography scan of the cervical esophagus.
Zoom Image
Fig. 3 The submucosal foreign body with a yellow “coat” exposed after cutting the mucosa.
Zoom Image
Fig. 4 The internal metal-like substance exposed after cleaning the surface.

Video 1 Extraction of a missing proximal esophageal foreign body by endoscopic mucosal dissection.


Quality:
Zoom Image
Fig. 5 Computed tomography scan 1 month after endoscopic mucosal dissection showing no evidence of esophageal foreign body.

Buried submucosal foreign bodies in the esophagus, although very rare, can cause serious complications [1]. The ESD procedure is safe for a buried and covered foreign body in the esophagus, and it could be the first choice of treatment [2] [3] [4]. However, how to determine the location is crucial.

Endoscopy_UCTN_Code_TTT_1AO_2AL

Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high
quality video and all contributions are
freely accessible online.

This section has its own submission
website at
https://mc.manuscriptcentral.com/e-videos


#

Competing interests

The authors declare that they have no conflict of interest.


Corresponding author

Xiaobo Cai, MD
Department of Gastroenterology
Shanghai General Hospital
School of Medicine
Shanghai Jiaotong University
Shanghai 200080
China   
Fax: +86-021-6324-0090   

Publication History

Publication Date:
23 September 2020 (online)

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany


Zoom Image
Fig. 1 Computed tomography of the larynx showing high-density foreign body in the wall of the upper esophagus (at about level 6/7 of the cervical vertebra) (arrow).
Zoom Image
Fig. 2 The position of the foreign body (yellow arrow) was determined by titanium clip (red arrow) combined with the computed tomography scan of the cervical esophagus.
Zoom Image
Fig. 3 The submucosal foreign body with a yellow “coat” exposed after cutting the mucosa.
Zoom Image
Fig. 4 The internal metal-like substance exposed after cleaning the surface.
Zoom Image
Fig. 5 Computed tomography scan 1 month after endoscopic mucosal dissection showing no evidence of esophageal foreign body.